Ins 3.32(4)(k)(k) Paying or offering to pay for services by a producer of title insurance if the services are required to be performed by the person in his or her capacity as a real estate or mortgage broker or salesperson or agent. Ins 3.32(4)(L)(L) Furnishing or offering to furnish, or paying or offering to pay for, furniture, office supplies, telephones, equipment or automobiles to a producer of title insurance, or paying for, or offering to pay for, any portion of the cost of renting, leasing, operating or maintaining any of these items. Marketing and title insurance promotional items clearly of an advertising nature of token or nominal value, or supplies such as title insurance application blanks and related forms are prohibited under this paragraph if they are made available to all producers of title insurance on the same terms and conditions. Ins 3.32(4)(m)(m) Paying for, furnishing, or waiving, or offering to pay for, furnish, or waive, all or any part of the rent for space occupied by a producer of title insurance. Ins 3.32(4)(n)(n) Renting or offering to rent space from a producer of title insurance, at a rent which is excessive when compared with rents for comparable space in the geographic area, or paying or offering to pay, rent based in whole or in part on the volume of business generated by a producer of title insurance except for a bona fide percentage lease based on the total volume of receipts of the title insurer when the services of that title insurer are offered from that location to the public generally. Ins 3.32(4)(o)(o) Paying or offering to pay for gifts, vacations, business trips, convention expenses, travel expenses, membership fees, registration fees, lodging or meals on behalf of a producer of title insurance, directly or indirectly, or supplying letters of credit, credit cards or any such benefits. This paragraph does not preclude reasonable, moderate and customary business entertainment and trade association activities and expense incurred and recorded by the title insurer or agent in the course of marketing its products and services. Ins 3.32(4)(p)(p) Paying or offering to pay money, prizes or other things of value to, or on behalf of, a producer of title insurance in a contest or promotional endeavor. This paragraph does not apply to offers or payments to trade associations or charitable or other functions where the thing of value is a contribution or donation rather than a business solicitation. Ins 3.32(4)(q)(q) Paying or offering to pay for advertising concerning the title insurer or agent in material distributed or promoted by a producer of title insurance, unless the payment is reasonable compensation for the advertising, is not greater than the amount charged for comparable advertising and any title insurer is permitted to advertise in the material on the same terms and conditions. Ins 3.32(4)(r)(r) Paying for or furnishing, or offering to pay for or furnish any brochures, billboards, or advertisements of a producer of title insurance, products or services appearing in newspapers, on the radio, or on television, or other advertising or promotional material published or distributed by, or on behalf of, a producer of title insurance. Ins 3.32(5)(5) Referral of title insurance applications. For the purpose of sub. (3) (b), an application or order for title insurance is presumed to be referred to an agent by an affiliate producer of title insurance if the affiliated producer of title insurance acts as a broker, agent, lender, representative or attorney in the transaction which results in the application or order and the application was not referred to the affiliate producer by an unaffiliated producer of title insurance. Ins 3.32 HistoryHistory: Cr. Register, December, 1975, No. 240, eff. 1-1-76; emerg. am. (1), (2) and (3) (a), eff. 6-22-76; am. (1) (2), (3) (a) and (4) (o), Register, September, 1976, No. 249, eff. 10-1-76; am. (2) and (3) (a), Register, March, 1979, No. 279, eff. 4-1-79; am. (2), (3) (c) (intro.), (d), (4) (intro.), (e) to (p) and (r), renum. (3) (a) and (e) to be (3) (e) and (cm) and am., cr. (3) (intro.), (a), (am), (bm) and (c) 4., r. and recr. (3) (b), (4) (q) and (5), Register, November, 1986, No. 371, eff. 12-1-86; emerg. am. (4) (j), eff. 7-5-88; am. (4) (j), Register, October, 1988, No. 396, eff. 1-1-89; correction in (5) made under s. 13.93 (2m) (b) 7., Stats., Register December 2002 No. 564. Ins 3.33Ins 3.33 Individual uniform application for health insurance. Ins 3.33(1)(1) Definitions. For purposes of this section: Ins 3.33(1)(a)(a) “Individual major medical health insurance policy” means a comprehensive health care plan offered by an insurer authorized to write individual health or disability insurance for an individual or family. Individual major medical health insurance policies excludes limited-scope dental and vision policies, specified disease policies, short-term medical, hospital indemnity, and other limited-benefit individual insurance products and policies issued by an association plan under a group policy that may be underwritten on an individual basis. Ins 3.33(1)(b)(b) “Individual uniform application” means the uniform questions and format for applications that are to be used by insurers offering individual major medical health insurance policies or certificates, including an individual major medical health insurance coverage provided through an association as individual coverage and underwritten on an individual basis and issued to individuals or families, as it appears as form OCI 26-503 in Appendix 1. Ins 3.33(2)(a)(a) In accordance with s. 601.41 (10), Stats., insurers offering individual major medical health insurance policies or certificates must use the questions in the same format as in form OCI 26-503 contained in Appendix 1 as the individual uniform application. The contents of the individual uniform application must not vary, except as permitted in sub. (3) (b), from the text or format including bold character, line spacing, the use of boxes around text and must use a type size of at least 10 points. Ins 3.33 NoteNote: A copy of the individual uniform application form OCI 26-503 (c. 06/2010), required in par. (a), may be obtained at no cost from the Office of the Commissioner of Insurance, P.O. Box 7873, Madison, WI 53707-7873, or at the Office’s web address: oci.wi.gov.
Ins 3.33(2)(b)(b) Insurers offering individual major medical health insurance policies or certificates must implement procedures and policies necessary to implement and utilize the individual uniform application. Ins 3.33(2)(c)(c) Insurers offering individual major medical health insurance policies or certificates must treat and accept a paper copy of the individual major medical health insurance application as an original provided the application is received by the insurer within 45 days from the date the application form was originally signed. Ins 3.33(3)(a)(a) Insurers offering individual major medical health insurance policies or certificates that permit applicants to complete the application through the insurer’s web site may not automatically populate or fill in answers to health questions on the application. An applicant shall answer each question. Insurers may change the order of questions but may not alter the content of any question from the individual uniform application. Insurers must separately request that the applicant respond to questions or information identified in sub. (5). Insurers must send a paper copy of the completed application to the applicant. The paper copy of the completed application must be in the same format as appears in form OCI 26-503 as contained in Appendix 1 and comply with sub. (6). Ins 3.33(3)(b)(b) If the insurer requires additional or clarifying information related to a response provided on the individual uniform application, an insurer may ask those questions as part of gathering the information contained in sub. (5) or during a separate contact. Insurers must not gather information unrelated to responses requested on the individual uniform application. If an applicant discloses information that is not requested on the individual uniform application, an insurer must not use that information for purposes of underwriting or making a rescission or reformation decision. Ins 3.33(4)(a)(a) Insurers offering individual major medical health insurance policies or certificates may permit applicants to complete the application verbally with an authorized, licensed intermediary or with an employee of the insurer asking the applicant the questions. The intermediary or employee must ask the applicant each question on the uniform individual applicant including each health question. Insurers may change the order of questions but may not alter the content of any question from the individual uniform application. Insurers must separately request that the applicant respond to questions or information identified in sub. (5). Insurers must send a paper copy of the completed application to the applicant. The paper copy of the completed application must be in the same format as appears in form OCI 26-503 as contained in Appendix 1 and comply with sub. (6). Ins 3.33(4)(b)(b) If the insurer requires additional or clarifying information related to a response provided on the individual uniform application, an insurer may ask those questions as part of gathering the information contained in sub. (5) or during a separate contact. Insurers must not gather information unrelated to responses requested on the individual uniform application. If an applicant discloses information that is not requested on the individual uniform application, an insurer must not use that information for purposes of underwriting or making a rescission or reformation decision. Ins 3.33(5)(a)(a) Insurers offering individual major medical health insurance policies or certificates must include a statement on the first page of the policy that the policy is guaranteed renewable except for the reasons stated s. 632.7495 (2), Stats. Ins 3.33(5)(b)(b) Insurers must include authorizations, releases, and notices compliant with state and federal law filed with the office as separate forms that will be presented with the individual uniform application but not considered a part of the application. Ins 3.33(5)(c)(c) Insurers may file a separate form information or election options for the applicant to select deductible, copayment, and coinsurance levels and elect, if applicable, provider networks. Additionally, insurers may include in the form premium payment options for the applicant to select. Ins 3.33(6)(6) Underwriting. Insurers shall comply with the provisions of s. Ins 3.28, including the requirement to return an accepted application as described in s. Ins 3.28 (5) (d), when underwriting a submitted individual uniform application. Ins 3.33 NoteNote: This section first applies to policies issued after July 1, 2010.
Ins 3.33 HistoryHistory: CR 10-068: cr. Register December 2010 No. 660, eff. 1-1-11. This form is designed for an individual’s initial application for coverage. Please contact the insurer with questions regarding this form.
Instructions: Please complete the entire application for each person for whom coverage is being sought. If a person is currently enrolled in Medicare, this application should not be completed for that enrolled individual. If additional pages are needed to fully complete this application, please attach, sign and date each page.
Primary Applicant/Insured Information:
* If you have a Social Security Number.
* If you have a Social Security Number.
Within the last Five (5) Years:
1. Infectious and Parasitic Diseases
2. Blood, Gland, Endocrine, Metabolic and Immune Disorders (other than HIV, ARC, AIDS)
3. Cancer, Cyst and Tumors
4. Mental/Nervous/Behavioral Disorders
5. Brain and Nervous System
6. Skin Disorders
7. Eyes, Ears, Nose
8. Mouth, Throat or Jaw
9. Heart or Circulatory System
10. Respiratory System
11. Digestive System
12. Urinary System
13. Male or Female Reproductive Systems
14. Pregnancy, Birth or Congenital Abnormalities
15. Muscular or Skeletal System
16. Miscellaneous
17. Other Injury, Illness, Treatment or Condition
18. Tobacco Use
19. Other Activities
ONLY complete this section if you need assistance with completing the medical information portion of this Application. Please note that this may require additional time to process your application.
Signature (or e-signature) of each listed child who has attained the age of 18
Complete this section if someone assisted you in the completion of this Application
Individual Uniform Application Form
OCI 26-503 (c. 06/2010)
Ins 3.34(2)(a)(a) This section applies to disability insurance policies as defined at s. 632.895 (1) (a), Stats., that are issued or renewed on or after January 1, 2010, including individual health and group health benefit plans. It applies to limited–scope plans including vision and dental plans but does not include hospital indemnity, income continuation, accident-only benefits, long-term care and Medigap policies. This section also applies to self-insured health plans as defined at s. 632.745 (24), Stats. Ins 3.34(2)(b)(b) For a disability insurance policy covering employees who are affected by a collective bargaining agreement this coverage under this section first applies as follows: Ins 3.34(2)(b)1.1. If the collective bargaining agreement contains provisions consistent with this law or that are silent on dependent eligibility, coverage under this section first applies the earliest of any of the following; the date the disability insurance policy is issued or renewed on or after January 1, 2010, or the date the self-insured health plan is established, modified, extended or renewed on or after January 1, 2010. Ins 3.34(2)(b)2.2. If the collective bargaining agreement contains provisions inconsistent with this law, the coverage under this section first applies on the date the health policy is first issued or renewed or a self-insured health plan is first established, modified, extended, or renewed on or after the earlier of the date the collectively bargained agreement expires, or the date the collectively bargained agreement it is modified, extended or renewed. Ins 3.34(3)(3) Definitions. In this section and for purposes of applying s. 632.885, Stats.: Ins 3.34(3)(a)(a) “Adult child” means a child of the applicant, enrollee or insured who meets the eligibility requirements of s. 632.885 (2), Stats., as applicable. Ins 3.34(3)(b)(b) “Premium contribution” means the amount the adult child is required to pay for coverage under the adult child’s employer-sponsored group health benefit plan or self-insured health plan. Ins 3.34(3)(c)(c) “Premium amount” means the additional amount the applicant or insured is required to pay for inclusion of the adult child under the applicant’s or insured’s health insurance policy or self-insured plan. Ins 3.34(4)(4) Premium Determination. To determine whether an adult child meets the eligibility standard in s. 632.885 (2) (a) 3., Stats., the insurer or self-insured health plan must use only the following: Ins 3.34 NoteNote: 2011 Wis. Act 32 repealed s. 632.885 (2) (a) 1. to 3., Stats. See s. 632.885 (2) (a), Stats. Ins 3.34(4)(a)(a) The amount of the adult child’s premium contribution. Ins 3.34(4)(b)(b) The amount of the applicant’s or insured’s premium amount. Ins 3.34(5)(a)(a) On or after January 1, 2010, an insurer and self-insured health plan shall offer coverage to an adult child of an applicant or insured as a new entrant when the applicant or insured requests enrollment of the adult child no later than 30 days after the date the adult child first becomes eligible according to this section. It is solely the applicant’s or insured’s decision whether or not to add eligible adult children to the plan to the extent permitted by law. Ins 3.34(5)(b)(b) Insurers and self-insured health plans may not limit or otherwise restrict the offer of coverage to an eligible adult child by requiring any of the following: Ins 3.34(5)(b)1.1. The eligible adult child to have been previously covered as a dependent. Ins 3.34(5)(b)3.3. The eligible adult child to demonstrate that he or she had previous creditable coverage. Ins 3.34(5)(b)4.4. The insured or applicant to have requested coverage for an eligible adult child the first time the child was eligible for coverage. Ins 3.34(5)(c)(c) Insurers offering individual disability insurance may individually rate the eligible adult child and apply preexisting condition waiting periods consistent with s. 632.76 (2) (ac) 2., Stats., and may apply elimination riders to the eligible adult child, but may not do either of the following: Ins 3.34(5)(c)1.1. Deny coverage to an eligible adult child when the applicant or insured requests coverage.
